Résumé
Background: Acute non-variceal upper gastrointestinal bleeding (ANVUGIB) is one of the most common acute and severe clinical entities. As the limited medical resource in remote regions or primary hospitals, it is necessary to explore an effective endoscopic hemostasis method in such a medical condition. Aims: To investigate the efficacy of norepinephrine injection combined with electrocoagulation under conventional endoscopy in patients with ANVUGIB. Methods: Clinical data of 123 ANVUGIB patients were collected retrospectively from January 2019 to December 2021 at the Kashgar Prefecture Second People’s Hospital. According to the endoscopic hemostasis method used initially, these patients were divided into group A (submucosal injection of norepinephrine), group B (electrocoagulation), group C (clip hemostasis) and group D (direct norepinephrine injection combined with electrocoagulation). The success rate of immediate hemostasis, operation time, rebleeding rate within 72 hours, and rate of transfer to surgery were compared between the four groups. Furthermore, the relationship between visual field during hemostasis and success of immediate hemostasis was analyzed. Results: In group D, all patients achieved success immediate hemostasis, the success rate (100%) was significantly higher than that in group A, group B, and group C (all P0.05). In patients treated with combined hemostasis, including initial combination strategy and failed cases transferred to combination strategy, a clear endoscopic visual field could be obtained in 94.2% of the cases, and the success rate of immediate hemostasis was 98.1%. Conclusions: Submucosal injection of norepinephrine combined with electrocoagulation under conventional endoscopy has a higher immediate hemostasis rate with lower rates of rebleeding and surgical transfer in ANVUGIB patients. This strategy is worthy for popularizing in remote regions and primary hospitals.
Résumé
From April 2017 to June 2020, 46 patients with acute non-variceal upper gastrointestinal bleeding (ANVUGIB) underwent endoscopic vascular embolization (EVE) in the Department of Gastroenterology of the First Affiliated Hospital of University of Science and Technology of China for rebleeding after endoscopic hemostasis therapy (including local drug injection, electrocoagulation, hemostatic clamp and ligation, etc.). All 46 patients immediately stopped bleeding after EVE, and the effective rate of immediate hemostasis was 100.0%. Postoperative abdominal pain occurred in 13 cases (28.3%), abdominal distension in 3 cases (6.5%) and fever in 2 cases (4.3%). The mucosa healed gradually under gastroscopy 3 and 12 months after the operation. No gastrointestinal rebleeding occurred during the follow-up. Therefore, EVE is a safe and effective method for ANVUGIB patients with failure of initial endoscopic hemostasis, which is worthy of further clinical study and application.
Résumé
Since 2015, the European Society of Gastrointestinal Endoscopy (ESGE), the Japan Gastroenterological Endoscopy Society (JGES), the Digestive Endoscopy Specialized Committee of Chinese Medical Doctor Association Endoscopy Physician Branch, the Asia-Pacific working group and the International Consensus Group have updated the guidelines for acute non-variceal upper gastrointestinal bleeding (ANVUGIB). This article summarized these recently published guidelines and made a systematic comparison from the aspects of pre-endoscopic management, endoscopic management, post-endoscopic management and secondary prophylaxis for providing a reference for standardizing the management process of ANVUGIB.
Résumé
Background: Acute non-variceal upper gastrointestinal bleeding (ANVUGIB) is a common critical illness in clinical practice. Early gastroscopic intervention may detect the bleeding lesion, and endoscopic treatment can be performed if necessary. Aims: To explore the value of ultra-early emergency gastroscopy (performed within 4 hours of bleeding) in patients with ANVUGIB. Methods: A total of 120 patients with ANVUGIB admitted from December 2019 to October 2020 at the Jinhua Hospital were recruited in this retrospective study. All patients received an emergency gastroscopy after admission. According to the timing of emergency gastroscopy, they were divided into three groups: ultra-early group (gastroscopy performed within 4 hours of bleeding), early group (gastroscopy performed within 4-24 hours of bleeding), and routine group (gastroscopy performed within 24-48 hours of bleeding). The detection rate of bleeding lesion and efficacy of endoscopic intervention were compared between the three groups. Results: The detection rate of bleeding lesion in ultra-early group was moderately higher than that in early group and routine group with no significant difference (94.6% vs. 89.7% and 86.4%, P>0.05). There were no significant differences in immediate hemostasis rate, rebleeding rate and mortality rate between the three groups (P>0.05). But the time of oral feeding, amount of blood transfusion, as well as the length and cost of hospital stay in ultra-early group were superior to those in early group and routine group (P<0.05). Conclusions: Ultra-early emergency gastroscopy within 4 hours of bleeding can increase the detection rate of bleeding lesion, accelerate the time of oral feeding, and reduce the amount of blood transfusion. It is beneficial for establishing definite diagnosis and may guide the treatment regimen in patients with ANVUGIB.
Résumé
Objective To observe the clinical effect of Qingre-Jiangni-Zhixue decoction combined with omeprazole sodium on acute non-variceal upper gastrointestinal bleeding. Methods A total of 64 patients with acute non-variceal upper gastrointestinal bleeding were divided into the observation group and control group according to random number table method, with 32 cases in each group. The control group was given the routine clinical treatment combined with omeprazole sodium, and the observation group was given Qingre-Jiangni-Zhixue decoction on the basis of the control group. After 7 days of continuous treatment, the basic clinical indexes (hemostasis time, blood transfusion volume, hospitalization time, 72 hours hemostasis rate, rebleeding rate), oxidative stress indexes (cortisol, malondialdehyde, antidiuretic hormone, blood glucose) and serum inflammatory factors (hs-CRP, TNF-α, IL-1β) were observed before and after treatment, and the clinical efficacy were evaluated. Results The total effective rate of the observation group was 90.6% (29/32), which was significantly higher than that of the control group 71.9% (23/32), with statistically significant (χ2=4.730, P=0.029). After treatment, the hemostasis time (18.86 ± 2.97 h vs. 29.12 ± 4.07 h, t=7.354),blood transfusion volume (559.32 ± 67.17 ml vs. 612.73 ± 75.81 ml, t=11.032),hospitalization time (5.43 ± 0.67 d vs. 9.26 ± 1.15 d, t=5.871) of the observation group were significantly lower than those of the control group (P<0.05). The 72 h hemostasis rate of the observation group was 3.1%, which was significantly lower than that of the control group 21.9%, with statistically significant (χ2=5.143, P<0.05). The rebleeding rate of the observation group was 96.9%, which was significantly higher than that of the control group 81.3% (χ2=4.010, P=0.045). After treatment, the cortisol level, the malondialdehyde level, blood glucose, antidiuretic hormone of the observation group were lower than those of the control group (t were 8.106, 4.976, 4.842, 5.093, all Ps<0.01). After treatment, the hs-CRP, serum TNF-α, serum IL-1β of the observation group were lower than those of the control group (t were 5.506, 4.983, 7.962, all Ps<0.01). Conclusions The application of Qingre-Jiangni-Zhixue decoction combined with omeprazole sodium can inhibit the expression of serum inflammatory cytokines in patients with acute non-variceal upper gastrointestinal bleeding, reduce the oxidative stress injury caused by bleeding, and improve the hemostatic efficiency.
Résumé
Acute non-variceal upper gastrointestinal bleeding (ANVUGIB) is one of the most common medical emergencies worldwide.In 2009,the first edition of "Guidelines for the diagnosis and treatment of acute non-variceal upper gastrointestinal bleeding"was published in China.These guidelines were updated in 2015,which aimed to provide the standard diagnosis and management for patients with ANVUGIB.Based on the rapid development of multiple disciplines and latest understanding of ANVUGIB,this new edition of guidelines was therefore released for standardizing the diagnosis and management process of ANVUGIB.